Organization · Type 2 NPI

Mountain Park Dialysis Center, LLC

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Marietta, GA

NPI number 1053976613 Active

Practice location

2550 Sandy Plains Rd Ste 160
Marietta, GA 30066-7210

Call (770) 509-1065 Map

Fax (770) 509-9912

Mailing address

5200 Virginia Way, Att: L&c Dept
Brentwood, TN 37027-7569

Specialties and licenses

Taxonomy	Code	License
End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary	261QE0700X	None listed

End-Stage Renal Disease (ESRD) Treatment Clinic/Center: Definition to come...

Other end-stage renal disease (esrd) treatment clinic/center providers in Marietta

See all in Marietta →

NPI record

NPI: 1053976613
Entity type: Organization (Type 2)
Issued: May 8, 2019
Last updated: Sep 17, 2025
Status: Active

Other names

<unavail>
Sandy Plains Dialysis · doing business as
Sandy Plains Dialysis · doing business as

Authorized official

Samuel T Wey
VP Licensure & Certification
(615) 341-6641

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

Is this your record? How to update it.

About NPI 1053976613

Mountain Park Dialysis Center, LLC's National Provider Identifier is 1053976613, issued on May 8, 2019. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Marietta, GA. The record was last updated on Sep 17, 2025.